From the Guidelines
Vitamin C should not be used as a standard treatment for sepsis, but it may be considered as an experimental therapy in specific cases, as the current evidence is inconsistent and of low quality. The most recent and highest quality study, published in 2022 1, suggests that high-dose vitamin C may be beneficial in sepsis management, but the evidence is still limited. The study recommends high-dose vitamin C with thiamine and hydrocortisone for sepsis, but notes that the evidence is based on small studies and more research is needed.
Some key points to consider when evaluating the use of vitamin C in sepsis management include:
- The antioxidant properties of vitamin C, which may help counteract oxidative stress and inflammation in sepsis 1
- The potential benefits of vitamin C in supporting endothelial function, improving microcirculation, and reducing vasopressor requirements 1
- The lack of high-quality evidence to support the use of vitamin C as a standard treatment for sepsis, with most studies being small and of low quality 1
- The need for further research to fully understand the potential benefits and risks of using vitamin C in sepsis management 1
In terms of specific dosing recommendations, the 2022 study suggests using high-dose vitamin C (200 mg/kg/day) for 4 days in patients with severe sepsis and acute respiratory failure 1. However, these recommendations are based on limited evidence and should be used with caution.
Overall, while vitamin C may have potential benefits in sepsis management, it should not be used as a standard treatment without further evidence. Patients with sepsis should receive prompt antibiotic therapy, source control, appropriate fluid resuscitation, and vasopressor support as needed, according to established sepsis protocols. Any use of vitamin C should be discussed with specialists and considered within the context of comprehensive sepsis management.
From the Research
Role of Vitamin C in Sepsis Management
- Vitamin C supplementation has been explored as a potential treatment for sepsis due to its antioxidant and immunoregulatory effects 2, 3, 4.
- Studies have shown that patients with sepsis often have lower levels of vitamin C, suggesting a potential benefit to supplementation 2, 5.
- A meta-analysis found that intravenous vitamin C may improve short-term and overall mortality in patients with sepsis, although the evidence was moderate-quality and more research is needed 2.
- A prospective cohort study found that adding vitamin C to conventional treatment decreased the risk of mortality by 46% in patients with sepsis and a SOFA score ≥ 9 3.
Mechanisms of Action
- Vitamin C may help reduce oxidative stress and inflammation in sepsis, which can lead to organ dysfunction 4, 5.
- Vitamin C may also enhance immune cell function and regulate the synthesis of various mediators and hormones 5.
- The combination of vitamin C, thiamine, and hydrocortisone has been studied as a potential adjunctive therapy for sepsis, although results have been inconsistent 4, 6.
Clinical Evidence
- A randomized controlled trial found that adding vitamin C, thiamine, and hydrocortisone to standard treatment did not improve in-hospital or 30-day mortality, but did reduce vasopressor use and improve lactate clearance 6.
- Another study found that vitamin C decreased proinflammatory mediators and slowed the progression of endothelial injury in severe sepsis 4.
- The optimal dosing and duration of vitamin C treatment for sepsis are still unclear, and more research is needed to determine its overall benefit 4.